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Clinical Trial
. 2011 Mar-Apr;44(2):208-16.
doi: 10.1016/j.jelectrocard.2010.08.012. Epub 2010 Nov 20.

A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: sum magnitude of the absolute QRST integral

Larisa G Tereshchenko  1 , Alan Cheng, Barry J Fetics, Barbara Butcher, Joseph E Marine, David D Spragg, Sunil Sinha, Darshan Dalal, Hugh Calkins, Gordon F Tomaselli, Ronald D Berger
Affiliations
Clinical Trial

A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: sum magnitude of the absolute QRST integral

Larisa G Tereshchenko et al. J Electrocardiol. 2011 Mar-Apr.

Abstract

Objective: We proposed and tested a novel electrocardiogram marker of risk of ventricular arrhythmias (VAs).

Methods: Digital orthogonal electrocardiograms were recorded at rest before implantable cardioverter-defibrillator (ICD) implantation in 508 participants of a primary prevention ICDs prospective cohort study (mean ± SD age, 60 ± 12 years; 377 male [74%]). The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. A derivation cohort of 128 patients was used to define a cutoff; a validation cohort (n = 380) was used to test a predictive value.

Results: During a mean follow-up of 18 months, 58 patients received appropriate ICD therapies. The SAI QRST was lower in patients with VA (105.2 ± 60.1 vs 138.4 ± 85.7 mV ms, P = .002). In the Cox proportional hazards analysis, patients with SAI QRST not exceeding 145 mV ms had about 4-fold higher risk of VA (hazard ratio, 3.6; 95% confidence interval, 1.96-6.71; P < .0001) and a 6-fold higher risk of monomorphic ventricular tachycardia (hazard ratio, 6.58; 95% confidence interval, 1.46-29.69; P = .014), whereas prediction of polymorphic ventricular tachycardia or ventricular fibrillation did not reach statistical significance.

Conclusion: High SAI QRST is associated with low risk of sustained VA in patients with structural heart disease.

Trial registration: ClinicalTrials.gov NCT00733590.

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Figures

Figure 1
Figure 1
Example of SAI QRST measurement. The sum of the areas under QRST curve on 3 orthogonal ECG leads is calculated.
Figure 2
Figure 2
Representative baseline SAI QRST ECG in a patient without (A) and one with (B) subsequent sustained ventricular tachyarrhythmia and appropriate ICD therapy at follow-up.
Figure 3
Figure 3
SAI QRST distribution in validation cohort patients without and with sustained VA at follow-up.
Figure 4
Figure 4
Kaplan-Meier curves for freedom from VT/VF events in validation cohort patients with the low, intermediate, and high SAI QRST. (A) Kaplan-Meyer all VT/VF events free survival; (B) Kaplan-Meyer MMVT events free survival; (C) Kaplan-Meyer PVT/VF events free survival.
Figure 5
Figure 5
Correlations between SAI QRST, body mass index (BMI) and heart function characteristics. (A) Correlation between the SAI QRST and LVDD; (B) Correlation between SAI QRST and LV EF; (C) Correlation between SAI QRST and BMI; (D) Correlation between SAI QRST and QT interval; (E) Correlation between SAI QRST and heart rate; (F) Correlation between SAI QRST and QRS width.
Figure 6
Figure 6
Results of ROC analysis. Receiver operating characteristic (ROC) curve on the prediction of the freedom from sustained VT/VF events. (A) for all patients; (B) for patients with narrow QRS ≤ 120ms; (C) for patients with wide QRS > 120 ms.
Figure 7
Figure 7
(A) Kaplan-Meier curves for freedom from VT/VF events in patients with the ICD and CRT-D device (N=508). (B) Kaplan-Meier curves for freedom from VT/VF events in CRT-D patients with the low, intermediate, and high SAI QRST.
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References

    1. Lloyd-Jones D, Adams R, Carnethon M, De SG, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:480–6. - PubMed
    1. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. 1997;337:1576–83. - PubMed
    1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83. - PubMed
    1. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. - PubMed
    1. Goldenberg I, Vyas AK, Hall WJ, Moss AJ, Wang H, He H, Zareba W, McNitt S, Andrews ML. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2008;51:288–96. - PubMed

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